Median effective dose of remifentanil for awake laryngoscopy and intubation
Median effective dose of remifentanil for awake laryngoscopy and intubation作者机构：Department of Anesthesiology Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China
出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)
年 卷 期：2009年第122卷第13期
页 面：1507-1512页
核心收录：
学科分类：12[管理学] 1204[管理学-公共管理] 120402[管理学-社会医学与卫生事业管理(可授管理学、医学学位)] 1004[医学-公共卫生与预防医学(可授医学、理学学位)] 10[医学]
主 题：laryngoscopy awake intubation remifentanil median effective dose sedation and analgesia
摘 要：Background Awake intubation requires an anesthetic management that provides sufficient patient safety and comfort, adequate intubating conditions, and stable hemodynamics. In this prospective clinical study, our aim was to determine the median effective dose （ED50） of remifentanil in combination with midazolam and airway topical anesthesia for awake laryngoscopy and intubation. Methods Thirty-six female adult patients, scheduled for elective plastic surgery under general anesthesia requiring orotracheal intubation were included in this study. Ten minutes after intravenous administration of midazolam 0.1 mg/kg, patients were assigned to receive remifentanil in bolus, followed by a continuous infusion. The bolus dose and infusion rate of remifentanil were adjusted by a modified Dixon＇s up-and-down method. Patient＇s reaction score at laryngoscopy and an Observer＇s Assessment of Alertness/Sedation Scale （OAA/S） were used to determine whether the remifentanil dosage regimen was accepted. During laryngoscopy, 2% lidocaine was sprayed into the airway to provide the topical anesthesia. ED50 of remifentanil was calculated by the modified Dixon up-and-down method, and the probit analysis was then used to confirm the results obtained from the modified Dixon＇s up-and-down method. In the patients who were scored as ＂accept＂, patient＇s OAA/S and reactJon scores at dJfferent observed points, JntubatJng conditJon score and patient＇s tolerance to the endotracheal tube after intubation were evaluated and recorded. Blood pressure and heart rate at different measuring points were also noted. Results ED50 of remifentanil for awake laryngoscopy and intubation obtained by the modified Dixon＇s up-and-down method was （0.62±0.02） μg/kg. Using probit analysis, ED50 and ED95 of remifentanil were 0.63 μg/kg （95% CI, 0.54-0.70） and 0.83 μg/kg （95% CI, 0.73-2.59）, respectively. Nineteen patients who were scored as ＂accept＂ had an OAA/S of 〉15 and tolerated well laryngoscopy without significant di
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